MRI-directed high-frequency (29MhZ) TRUS-guided biopsies: initial results of a single-center study

Eur Radiol. 2020 Sep;30(9):4838-4846. doi: 10.1007/s00330-020-06882-x. Epub 2020 Apr 29.

Abstract

Objectives: To evaluate the ability of high-frequency (29 MHz) transrectal micro-ultrasound (microUS) as a second-look examination after biparametric MRI (bp-MRI) and to reidentify focal lesions seen on diagnostic MRI and to detect new ones METHODS: A total of 118 consecutive men (mean age, 66 ± 13 [SD] years; range, 49-93 years) with a mean prostate-specific antigen level of 11 ± 19 (SD) ng/mL (range, 2-200 ng/mL) and at least one focal lesion (MRI+) with a score > 2 on bp-MRI were included. Of these, 79/118 (66.9%) were biopsy-naïve and 102/118 (86.5%) had non-suspicious rectal examination. All patients had MRI-directed microUS-guided biopsy using a 29-MHz transducer. All lesions visible on micro-ultrasound (microUS+) were targeted without image fusion, which was only used for MRI+/microUS- lesions. Significant prostate cancer (sPCa) was defined by a Gleason score ≥ 7 or a maximum cancer core length > 3 mm.

Results: A total of 144 focal prostatic lesions were analyzed, including 114 (114/144, 79.2%) MRI+/microUS+ lesions, 13 MRI+/microUS- lesions (13/144, 9%), and 17 MRI-/microUS+ lesions (17/144, 11.8%). Significant PCa was detected in 70 MRI+/microUS+ lesions (70/114, 61.4%), in no MRI+/microUS- lesion (0/13, 0%), and in 4 MRI-/microUS+ lesions (4/17, 23.5%). The sensitivity and specificity of microUS on a per-patient and a per-lesion basis were 100% (95% CI, 84.9-100%) and 22.8% (95% CI, 12.5-35.8%) and 100% (95% CI, 85.1-100%) and 22.6% (95% CI, 12.3-36.2%), respectively.

Conclusion: MicroUS, as a second-look examination, may show promise to localize targets detected on bp-MRI.

Key points: • Used as a second-look examination, microUS-guided biopsies have a 100% detection rate of sCa originating in the PZ or lower third of the TZ, without microUS-MRI image fusion. • MicroUS results may provide additional information about lesions visible on MRI. • MicroUS may provide the ability to detect small PZ lesions undetected by bp-MRI.

Keywords: Biopsy; Magnetic resonance imaging; Prostatic neoplasms; Ultrasonography.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / blood
  • Endosonography / methods*
  • Humans
  • Image-Guided Biopsy / methods*
  • Kallikreins / blood
  • Magnetic Resonance Imaging, Interventional / methods*
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / metabolism
  • Urethra

Substances

  • Biomarkers, Tumor
  • Kallikreins
  • kallikrein-related peptidase 3, human
  • Prostate-Specific Antigen